BILL ANALYSIS Ó
AB 1129
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Date of Hearing: April 14, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 1129
Burke - As Amended April 6, 2015
SUBJECT: Emergency medical services: data and information
system.
SUMMARY: Requires an emergency medical services (EMS) provider,
when collecting and sharing data with a local emergency medical
services agency (LEMSA), to use a system compatible with
California Emergency Medical Services Information System
(CEMSIS) and National Emergency Medical Services Information
System (NEMSIS) standards, as specified. Prohibits a LEMSA from
mandating that an EMS provider use a specific system to collect
and share this data.
EXISTING LAW:
1)Establishes the state EMSA which is responsible for the
coordination and integration of all state activities
concerning EMS, including establishing the minimum standards
for the policies and procedures necessary for medical control
of the EMS system.
2)Requires EMSA, utilizing local and regional information to
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asses each EMS area or LEMSA service area to determine the
need for additional EMS services, coordination of EMS
services, and the effectiveness of EMS services.
3)Requires EMSA to develop planning and implementation
guidelines for EMS systems which address specified components,
including communications, system organization and management,
and data collection and evaluation.
4)Authorizes counties to develop an EMS program and designate a
LEMSA responsible for planning and implementing an EMS system,
which includes day-to-day EMS system operations.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, current law
authorizes LEMSAs to plan, implement, and oversee day-to-day
EMS in California. In order to monitor local EMS providers
and services, LEMSAs collect data from those providers. The
author further states, as local providers have shifted to
electronic patient records; the potential for better analysis
of EMS has increased. LEMSAs are able to provide the data
they collect from EMS providers to EMSA through CEMSIS
compatible software. Although the software and hardware must
be compatible with CEMSIS, there are many different systems in
use and many more available. The author explains that without
guidelines in law, LEMSAs are able to require EMS providers in
their jurisdiction to purchase specific software or hardware
for data collection. By requiring providers that cover
multiple counties or contract with multiple LEMSAs, purchase
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specific software and/or hardware can be an unnecessary and
costly burden. The author asserts existing law is silent on
whether or not a LEMSA can require a specific hardware or
software provider for EMS providers in their jurisdiction.
2)BACKGROUND. NEMSIS was formed in 2001 by the National
Association of State EMS Directors, in conjunction with the
National Highway Traffic Safety Administration and the
Trauma/EMS Systems program of the Health Resources and
Services Administration's Maternal Child Health Bureau, in
order to develop a national EMS database. NEMSIS is the
national repository that will be used to potentially store EMS
data from every state in the nation, and was developed to help
states collect more standardized elements to allow submission
to the national database.
According to EMSA, CEMSIS is a demonstration project for
improving EMS data analysis across California. CEMSIS offers a
secure, centralized data system for collecting data about
individual EMS requests, patients treated at hospitals, and
EMS provider organizations. EMSA states that at least 14 of
California's 33 LEMSAs currently send a variety of local data
collections to CEMSIS on a voluntary basis, and in return,
these local agencies gain access to digital tools for running
comprehensive reports on their own data at no cost.
EMSA states when fully operational with 100% local
participation, it is estimated that CEMSIS will catalogue more
than 3 million EMS events per year. According to EMSA, it
will use the data to develop and coordinate high quality
emergency medical care in California through activities such
as healthcare quality programs that monitor patient care
outcomes, agency collaboration across jurisdictional
boundaries, and public health surveillance.
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On October 1, 2014, the NEMSIS Technical Advisory Committee
announced that California was the first state to successfully
transmit NEMSIS Version 3 EMS data to the national repository
using field and statelevel software "certified compliant".
NEMSIS Version 3, provides a set of tools that EMS
professionals can use to integrate EMS patient care data with
electronic medical records at hospitals, leading to better
patient outcomes and a smarter system of care.
3)SUPPORT. The California Ambulance Association, the sponsor of
this bill, along with the Los Angeles County Ambulance
Association, and several ambulance providers write in support
of this bill. Supporters state that the growing practice of
LEMSAs to direct or require EMS providers in their region to
purchase and employ specific software vendors undermines the
purpose of a universal standard allowing providers to use
whatever system is most efficient and effective for their area
of operation, so long as it complies with the universal
standard. Supporters write that there are numerous programs
and vendors compatible with NEMSIS standards that can
facilitate the exchange of healthcare information the state
and federal data repositories.
4)OPPOSITION. The California Right to Life Committee (CRLC)
writes in opposition to this bill. The CRLC is concerned
about the provision of the bill that would require the EMS
providers' data systems be integrated with the LEMSA's data
system and this could eventually include data on a statewide
Physicians' Orders for Life Sustaining Treatment Registry
(POLST) or other similar end of life registries. CRLC is
opposed to a POLST type form of end of life decisionmaking in
which medical and nonmedical complete the form and the patient
is not required to sign or verify the statements. If a
person's name is automatically entered into a statewide or
national registry, the person may not be treated properly if
paramedics are called and their true choices for end of life
decisions may not be known.
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5)POLST. According to the POLST Legislative Guide, approved
February 28, 2014 by the National POLST Paradigm Task Force,
the POLST Paradigm is a clinical process designed to
facilitate communication between health care professionals and
patients with serious illness or frailty (or their authorized
surrogate). The POLST paradigm promotes the use of a highly
visible, portable medical form that transfers from one setting
to another with the patient. Current law requires the form to
be completed by a health care provider based on patient
preferences and medical indications, and signed by a physician
and the patient or his or her "legally recognized health care
decision maker." Current law requires the health care
provider, during the process of completing the form, to inform
the patient about the difference between an advance health
care directive and the POLST form. An advance health care
directive is a health care instruction or a power of attorney
for health care that allows an individual to provide their
health care decisions or assign a legal representative to make
medical decisions on their behalf. Unlike the POLST, state
law requires information about end of life care, advance
health care directives, and registration of the advance health
care directives at a registry available on the Websites of the
Secretary of State, the Department of Health Care Services,
the office of the Attorney General, the Department of Managed
Health Care, the California Department of Insurance, the Board
of Registered Nursing, and the Medical Board of California.
6)OPPOSE UNLESS AMENDED. The Emergency Medical Services
Administrators Association of California and the EMS Medical
Directors Association of California are both opposed to this
bill, unless it is amended. The opposition writes that
although they are supportive of the concept of the use of
electronic EMS data, they are opposed to the prohibition of
LEMSAs mandating specific data collection systems. According
to the opposition, while it is uncommon for a LEMSA to require
a single system-wide patient care record system, such an
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approach could be in the best interest of patients to assure
the transfer and continuity of patient care data from
prehospital providers, receiving hospitals, and specialty care
centers.
7)RELATED LEGISLATION.
a) AB 70 (Waldron) changes the reporting requirement that
EMSA report annually to the Legislature on the
effectiveness of the statewide trauma system to once every
five years. AB 70 is currently pending hearing in the
Assembly Health Committee.
b) AB 503 (Rodriguez) allows a health facility to release
patient-identifiable medical information to an EMS provider
and LEMSA when specific data elements are requested for the
purpose of quality assessment and improvement. Requires
EMSA to develop minimum standards for the implementation of
this data collection system. AB 503 was hear in this
Committee on April 7, 2015 and passed on a vote of 17-0 and
is currently pending the Assembly Appropriations Committee.
c) AB 430 (Roger Hernández) requires EMSA to develop a
statewide trauma plan that addresses all aspects of a
trauma care system and report the status the plan to the
Legislature no later than March 31, 2016. Requires LEMSAs
implementing trauma care systems to commission an
independent nonprofit organization or governmental entity
qualified to assess trauma systems to conduct a
comprehensive regional assessment of equitability and
access to its trauma system at least once every five years.
AB 430 is currently pending hearing in the Assembly Health
Committee.
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d) AB 791 (Cooley) requires DHCS to establish a registry
for people to file their end of life directives. AB 791 is
pending hearing in this Committee
e) AB 637 (Campos) expands the ability to sign a POLST form
to nurse practitioners and physician assistants (current
law only allows a physician to sign the POLST form). AB
637 passed the Assembly Judiciary Committee on April 7,
2015 on a vote of 10-0.
8)PREVIOUS LEGISLATION.
a) AB 1975 (Roger Hernández) of 2014 would have required
LEMSAs to contract with the American College of Surgeons
every five years to conduct a comprehensive assessment of
the county trauma system. AB 1975 was held on the Suspense
file in the Assembly Appropriations Committee.
b) AB 1621 (Lowenthal and Rodriguez), also of 2014, would
have required EMSA to develop the State Emergency Medical
Services Data and Information System in order to assess
each EMS area or LEMSAs service area to determine the need
for additional EMS services, coordination of EMS services,
and the effectiveness of EMS. AB 1621 was held on the
Suspense file in the Senate Appropriations Committee.
c) SB 266 (Romero) of 2005 would have required EMSA to
establish a trauma care advisory committee and required the
committee to develop a statewide trauma care plan by
January 1, 2007. SB 266 was vetoed by Governor
Schwarzenegger, stating " I am directing EMSA, informed by
its Trauma Advisory Committee, to complete its statewide
trauma care plan and provide me recommendations by no later
than June 1, 2006."
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d) AB 1988 (Diaz), Chapter 333, Statutes of 2002, requires
EMSA to convene a task force to study the delivery and
provision of EMS. Requires the task force, among other
things, to develop a plan to ensure that all Californians
are served by appropriate coverage areas for emergency and
trauma services and that sufficient numbers of emergency
departments and trauma centers exist to serve each area's
population.
REGISTERED SUPPORT / OPPOSITION:
Support
Ambulance Association of Orange County (sponsor)
AmbuServe Ambulance
California Ambulance Association
Care Ambulance Service, Inc.
Emergency Ambulance Service, Inc.
Los Angeles County Ambulance Association, Inc.
Shoreline Ambulance
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Opposition
California Right to Life Committee, Inc.
Analysis Prepared by:Patty Rodgers / HEALTH / (916) 319-2097